Top Tweets for #generalAnesthesia

Doç. Dr. Hasan Ersöz | Pectus & Ribella @izmirgoguscerr

4 days ago

💉 Ozempic kullanırken Ribella® yapılabilir mi? Ribella® için başvuran hastalarımızdan son dönemde bu soruyu daha sık duymaya başladık. #ribella #ozempic #ribremodeling #waistcontouring #generalanesthesia

500Ways @500wayscom

4 days ago

Discover the worst adoption of anesthesia. It's free and complete at https://t.co/9IXDTjz0W7 (#anesthesia, #medicine, #medical, #chloroform, #ether, #generalAnesthesia, #medicalHistory, #discoveryOfAnesthesia, #earlyMedicine, #QueenVictoria, #anesthetic)

500wayscom's tweet photo. Discover the worst adoption of anesthesia. It's free and complete at https://t.co/9IXDTjz0W7 (#anesthesia, #medicine, #medical, #chloroform, #ether, #generalAnesthesia, #medicalHistory, #discoveryOfAnesthesia, #earlyMedicine, #QueenVictoria, #anesthetic) https://t.co/moZ9PowPnN

A Chronic Voice @AChVoice

3 months ago

"Under #GeneralAnesthesia, the conscious mind shuts off—or so we have long thought. But a new study of people in this state suggests the anesthetized #brain still picks up #sounds, #words & even conversations": https://t.co/jzw1jpABx9 via @sciam #anesthesia #MedTwitter #research

127

Dr.Kartik Sonawane

@KartikBSonawane

5 months ago

❤️‍🩹 𝐋𝐎𝐖 𝐄𝐅, 𝐍𝐨 𝐆𝐔𝐄𝐒𝐒𝐖𝐎𝐑𝐊 : 𝐒𝐌𝐀𝐑𝐓 𝐏𝐄𝐑𝐈𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐏𝐄𝐀𝐑𝐋𝐒❤️‍🩹 #LowEF #HeartFailure #PerioperativeMedicine #Anesthesia #GeriatricAnesthesia #RegionalAnesthesia #NeuraxialAnesthesia #GeneralAnesthesia #GrayZonesInRA #GrayAreasInRA 𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀: Managing patients with low EF is all about preventing sudden swings. They are, PRELOAD sensitive, AFTERLOAD vulnerable, RHYTHM dependent, HYPOXIA intolerant, ANEMIA intolerant, and FLUID-OVERLOAD intolerant. 1️⃣ 🧭 𝐏𝐑𝐄𝐎𝐏: 𝐊𝐍𝐎𝐖𝐈𝐍𝐆 𝐓𝐇𝐄 𝐇𝐄𝐀𝐑𝐓 🔹 EF is only a number - assess physiology 🔹 Look for red flags: dyspnea, edema, orthopnea, tachycardia 🔹 Postpone elective surgery if HF is decompensated 🔹 Continue chronic beta-blockers 🔹 Stop SGLT2 inhibitors 3–4 days before surgery 🔹 Individualize ACEI/ARB/ARNI & diuretics 🔹 Plan anticoagulation & antiplatelet strategy early 2️⃣💧 𝐅𝐋𝐔𝐈𝐃𝐒: 𝐓𝐈𝐍𝐘 𝐁𝐎𝐋𝐔𝐒, 𝐓𝐈𝐆𝐇𝐓 𝐑𝐄𝐀𝐒𝐒𝐄𝐒𝐒𝐌𝐄𝐍𝐓 🔹 Avoid blind fluid loading 🔹 Give 100–150 mL bolus, then reassess 🔹 Replace loss, not fear 🔹 Use POCUS when unsure 🔹 Start vasopressor early if vasodilated 🔹 Avoid both underfilling & overload 3️⃣🩸 𝐁𝐋𝐎𝐎𝐃: 𝐏𝐑𝐎𝐓𝐄𝐂𝐓 𝐎𝐗𝐘𝐆𝐄𝐍, 𝐀𝐕𝐎𝐈𝐃 𝐎𝐕𝐄𝐑𝐋𝐎𝐀𝐃 🔹 Correct anemia preoperatively 🔹 Do not transfuse by Hb alone 🔹 Transfuse one unit at a time 🔹 Reassess after each unit 🔹 Prevent bleeding: TXA, cell salvage, warming, calcium, TEG/ROTEM when available 4️⃣💉 𝐏𝐑𝐄𝐒𝐒𝐎𝐑𝐒 & 𝐈𝐍𝐎𝐓𝐑𝐎𝐏𝐈𝐂: 𝐓𝐑𝐄𝐀𝐓 𝐓𝐇𝐄 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌 🔹 Norepinephrine: vasodilated hypotension 🔹 Dobutamine: low output, poor contractility 🔹 Milrinone: LV dysfunction with PH/RV strain 🔹 Vasopressin: catecholamine-resistant vasoplegia 🔹 Phenylephrine: use cautiously (may increase afterload) 🔹 Epinephrine: rescue for severe myocardial depression 5️⃣�� 𝐓𝐀𝐑𝐆𝐄𝐓𝐒: 𝐒𝐋𝐎𝐖 𝐇𝐄𝐀𝐑𝐓, 𝐅𝐔𝐋𝐋 𝐂𝐎𝐑𝐎𝐍𝐀𝐑𝐈𝐄𝐒, 𝐃𝐑𝐘 𝐋𝐔𝐍𝐆𝐒 🔹 Avoid hypotension 🔹 Avoid tachycardia 🔹 Avoid severe bradycardia 🔹 Maintain sinus rhythm 🔹 Avoid sudden afterload drop 🔹 Avoid sudden afterload rise 🔹 Maintain oxygenation and coronary perfusion 6️⃣🫁 𝐆𝐀: 𝐒𝐌𝐎𝐎𝐓𝐇 𝐈𝐍, 𝐒𝐌𝐎𝐎𝐓𝐇 𝐎𝐔𝐓 🔹 Induce slowly 🔹 Titrate small doses 🔹 Avoid deep volatile anesthesia 🔹 Ventilate gently 🔹 Avoid hypoxia, hypercarbia, acidosis, high PEEP 🔹 Extubate smoothly 🔹 Plan HDU/ICU when risk is high 7️⃣🦴 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋: 𝐂𝐎𝐍𝐓𝐑𝐎𝐋𝐋𝐄𝐃 𝐒𝐘𝐌𝐏𝐀𝐓𝐇𝐄𝐂𝐓𝐎𝐌𝐘 🔹 Not automatically safer than GA 🔹 Avoid dense high spinal 🔹 Prefer low-dose spinal when suitable 🔹 Titrate epidural/CSE slowly 🔹 Keep pressors ready 🔹 Use peripheral nerve blocks as allies 🔹 Choose the technique with least hemodynamic swing 8️⃣👴 𝐆𝐄𝐑𝐈𝐀𝐓𝐑𝐈𝐂 𝐋𝐎𝐖 𝐄𝐅: 𝐒𝐌𝐀𝐋𝐋 𝐃𝐎𝐒𝐄, 𝐁𝐈𝐆 𝐂𝐎𝐍𝐒𝐄𝐐𝐔𝐄𝐍𝐂𝐄𝐒 🔹 Start low, go slow 🔹 Avoid delirium triggers 🔹 Protect kidneys 🔹 Avoid oversedation 🔹 Mobilize early 🔹 Use multimodal analgesia 9️⃣ 🖥️ 𝐌𝐎𝐍𝐈𝐓𝐎𝐑𝐈𝐍𝐆: 𝐒𝐄𝐄 𝐄𝐀𝐑𝐋𝐘, 𝐀𝐂𝐓 𝐄𝐀𝐑𝐋𝐘 🔹 Arterial line 🔹 POCUS early 🔹 Do not rely on CVP alone 🔹 Watch urine output, lactate, perfusion, temperature 🔹 Monitor postoperative troponin in high-risk patients 🔹 Decide postoperative destination before induction 🔟 🚨 𝐇𝐘𝐏𝐎𝐓𝐄𝐍𝐒𝐈𝐎𝐍 𝐀𝐋𝐆𝐎𝐑𝐈𝐓𝐇𝐌 🔹 Pause and check 🔹 Classify the phenotype 🔹 Correct the cause 🔹 Reassess and repeat 🔹 Use echo early 🔹 Don’t treat every low BP with fluid 1️⃣1️⃣🔥 𝐏𝐎𝐒𝐓𝐎𝐏: 𝐕𝐈𝐆𝐈𝐋𝐀𝐍𝐂𝐄 𝐃𝐎𝐄𝐒𝐍’𝐓 𝐄𝐍𝐃 𝐀𝐓 𝐒𝐊𝐈𝐍 𝐂𝐋𝐎𝐒𝐔𝐑𝐄 🔹 Control pain 🔹 Prevent shivering 🔹 Avoid hypoxia 🔹 Watch fluid creep 🔹 Restart HF drugs when stable 🔹 Look for arrhythmia, ischemia, AKI, delirium 🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒 🔹 In low EF patients, the safest anesthesia is not GA or Neuraxials. 🔹 It is the technique that produces the least hemodynamic swing. 𝐋𝐨𝐰 𝐄𝐅 = 𝐋𝐨𝐰 𝐌𝐚𝐫𝐠𝐢𝐧 ✅ Plan ahead. Optimize. Monitor closely. Treat early. Team approach. Safe outcomes.

KartikBSonawane's tweet photo. ❤️‍🩹 𝐋𝐎𝐖 𝐄𝐅, 𝐍𝐨 𝐆𝐔𝐄𝐒𝐒𝐖𝐎𝐑𝐊 : 𝐒𝐌𝐀𝐑𝐓 𝐏𝐄𝐑𝐈𝐎𝐏𝐄𝐑𝐀𝐓𝐈𝐕𝐄 𝐏𝐄𝐀𝐑𝐋𝐒❤️‍🩹

#LowEF #HeartFailure #PerioperativeMedicine #Anesthesia #GeriatricAnesthesia #RegionalAnesthesia #NeuraxialAnesthesia #GeneralAnesthesia
#GrayZonesInRA #GrayAreasInRA

𝐆𝐑𝐀𝐘 𝐙𝐎𝐍𝐄𝐒 𝐢𝐧 𝐑𝐀:

Managing patients with low EF is all about preventing sudden swings.

They are,

PRELOAD sensitive,
AFTERLOAD vulnerable,
RHYTHM dependent,
HYPOXIA intolerant,
ANEMIA intolerant, and
FLUID-OVERLOAD intolerant.

1️⃣ 🧭 𝐏𝐑𝐄𝐎𝐏: 𝐊𝐍𝐎𝐖𝐈𝐍𝐆 𝐓𝐇𝐄 𝐇𝐄𝐀𝐑𝐓

🔹 EF is only a number - assess physiology
🔹 Look for red flags: dyspnea, edema, orthopnea, tachycardia
🔹 Postpone elective surgery if HF is decompensated
🔹 Continue chronic beta-blockers
🔹 Stop SGLT2 inhibitors 3–4 days before surgery
🔹 Individualize ACEI/ARB/ARNI & diuretics
🔹 Plan anticoagulation & antiplatelet strategy early

2️⃣💧 𝐅𝐋𝐔𝐈𝐃𝐒: 𝐓𝐈𝐍𝐘 𝐁𝐎𝐋𝐔𝐒, 𝐓𝐈𝐆𝐇𝐓 𝐑𝐄𝐀𝐒𝐒𝐄𝐒𝐒𝐌𝐄𝐍𝐓

🔹 Avoid blind fluid loading
🔹 Give 100–150 mL bolus, then reassess
🔹 Replace loss, not fear
🔹 Use POCUS when unsure
🔹 Start vasopressor early if vasodilated
🔹 Avoid both underfilling & overload

3️⃣🩸 𝐁𝐋𝐎𝐎𝐃: 𝐏𝐑𝐎𝐓𝐄𝐂𝐓 𝐎𝐗𝐘𝐆𝐄𝐍, 𝐀𝐕𝐎𝐈𝐃 𝐎𝐕𝐄𝐑𝐋𝐎𝐀𝐃

🔹 Correct anemia preoperatively
🔹 Do not transfuse by Hb alone
🔹 Transfuse one unit at a time
🔹 Reassess after each unit
🔹 Prevent bleeding: TXA, cell salvage, warming, calcium, TEG/ROTEM when available

4️⃣💉 𝐏𝐑𝐄𝐒𝐒𝐎𝐑𝐒 & 𝐈𝐍𝐎𝐓𝐑𝐎𝐏𝐈𝐂: 𝐓𝐑𝐄𝐀𝐓 𝐓𝐇𝐄 𝐌𝐄𝐂𝐇𝐀𝐍𝐈𝐒𝐌

🔹 Norepinephrine: vasodilated hypotension
🔹 Dobutamine: low output, poor contractility
🔹 Milrinone: LV dysfunction with PH/RV strain
🔹 Vasopressin: catecholamine-resistant vasoplegia
🔹 Phenylephrine: use cautiously (may increase afterload)
🔹 Epinephrine: rescue for severe myocardial depression

5️⃣�� 𝐓𝐀𝐑𝐆𝐄𝐓𝐒: 𝐒𝐋𝐎𝐖 𝐇𝐄𝐀𝐑𝐓, 𝐅𝐔𝐋𝐋 𝐂𝐎𝐑𝐎𝐍𝐀𝐑𝐈𝐄𝐒, 𝐃𝐑𝐘 𝐋𝐔𝐍𝐆𝐒

🔹 Avoid hypotension
🔹 Avoid tachycardia
🔹 Avoid severe bradycardia
🔹 Maintain sinus rhythm
🔹 Avoid sudden afterload drop
🔹 Avoid sudden afterload rise
🔹 Maintain oxygenation and coronary perfusion

6️⃣🫁 𝐆𝐀: 𝐒𝐌𝐎𝐎𝐓𝐇 𝐈𝐍, 𝐒𝐌𝐎𝐎𝐓𝐇 𝐎𝐔𝐓

🔹 Induce slowly
🔹 Titrate small doses
🔹 Avoid deep volatile anesthesia
🔹 Ventilate gently
🔹 Avoid hypoxia, hypercarbia, acidosis, high PEEP
🔹 Extubate smoothly
🔹 Plan HDU/ICU when risk is high

7️⃣🦴 𝐍𝐄𝐔𝐑𝐀𝐗𝐈𝐀𝐋: 𝐂𝐎𝐍𝐓𝐑𝐎𝐋𝐋𝐄𝐃 𝐒𝐘𝐌𝐏𝐀𝐓𝐇𝐄𝐂𝐓𝐎𝐌𝐘

🔹 Not automatically safer than GA
🔹 Avoid dense high spinal
🔹 Prefer low-dose spinal when suitable
🔹 Titrate epidural/CSE slowly
🔹 Keep pressors ready
🔹 Use peripheral nerve blocks as allies
🔹 Choose the technique with least hemodynamic swing

8️⃣👴 𝐆𝐄𝐑𝐈𝐀𝐓𝐑𝐈𝐂 𝐋𝐎𝐖 𝐄𝐅: 𝐒𝐌𝐀𝐋𝐋 𝐃𝐎𝐒𝐄, 𝐁𝐈𝐆 𝐂𝐎𝐍𝐒𝐄𝐐𝐔𝐄𝐍𝐂𝐄𝐒

🔹 Start low, go slow
🔹 Avoid delirium triggers
🔹 Protect kidneys
🔹 Avoid oversedation
🔹 Mobilize early
🔹 Use multimodal analgesia

9️⃣ 🖥️ 𝐌𝐎𝐍𝐈𝐓𝐎𝐑𝐈𝐍𝐆: 𝐒𝐄𝐄 𝐄𝐀𝐑𝐋𝐘, 𝐀𝐂𝐓 𝐄𝐀𝐑𝐋𝐘

🔹 Arterial line
🔹 POCUS early
🔹 Do not rely on CVP alone
🔹 Watch urine output, lactate, perfusion, temperature
🔹 Monitor postoperative troponin in high-risk patients
🔹 Decide postoperative destination before induction

🔟 🚨 𝐇𝐘𝐏𝐎𝐓𝐄𝐍𝐒𝐈𝐎𝐍 𝐀𝐋𝐆𝐎𝐑𝐈𝐓𝐇𝐌

🔹 Pause and check
🔹 Classify the phenotype
🔹 Correct the cause
🔹 Reassess and repeat
🔹 Use echo early
🔹 Don’t treat every low BP with fluid

1️⃣1️⃣🔥 𝐏𝐎𝐒𝐓𝐎𝐏: 𝐕𝐈𝐆𝐈𝐋𝐀𝐍𝐂𝐄 𝐃𝐎𝐄𝐒𝐍’𝐓 𝐄𝐍𝐃 𝐀𝐓 𝐒𝐊𝐈𝐍 𝐂𝐋𝐎𝐒𝐔𝐑𝐄

🔹 Control pain
🔹 Prevent shivering
🔹 Avoid hypoxia
🔹 Watch fluid creep
🔹 Restart HF drugs when stable
🔹 Look for arrhythmia, ischemia, AKI, delirium

🎯 𝐊𝐄𝐘 𝐓𝐀𝐊𝐄𝐀𝐖𝐀𝐘𝐒

🔹 In low EF patients, the safest anesthesia is not GA or Neuraxials.
🔹 It is the technique that produces the least hemodynamic swing.

𝐋𝐨𝐰 𝐄𝐅 = 𝐋𝐨𝐰 𝐌𝐚𝐫𝐠𝐢𝐧

✅ Plan ahead. Optimize. Monitor closely. Treat early. Team approach. Safe outcomes.

580

Dr.Kartik Sonawane

@KartikBSonawane

8 months ago

🧠 RA & ANS: E. Parasympathetic Nervous System - Anatomy • Connections • Anesthetic Implications 🎯 #ParasympatheticSystem #RAandANS #CraniosacralOutflow #VagusNerve #AutonomicBalance #RegionalAnesthesia #GeneralAnesthesia #SpinalAnesthesia #HighSpinal #Bradycardia #AnatomyMatters #TipofTheDay #MyRATips Tip of the Day: 🟢 CRANIOSACRAL OUTFLOW 🔹 Brainstem nuclei →CN III, VII, IX, X 🔹 Sacral spinal cord → S2–S4 🔹 Long preganglionic fibers 🔹 Ganglia located near or within target organs 🔹 Neurotransmitter: Acetylcholine (ACh) 🧩 NEUROCHEMICAL ORGANIZATION 🟡 Preganglionic → ACh → Nicotinic receptors 🟢 Postganglionic → ACh → Muscarinic receptors 🔵 Highly organ-specific response (localized effect) 👁 CRANIAL Parasympathetic Pathways 🔸 CN III → Pupillary constriction & accommodation 🔸 CN VII → Lacrimal & salivary secretion 🔸 CN IX → Parotid secretion 🔸 CN X (Vagus) → Heart, Lungs, GI tract 🔥 PEARL: Vagus nerve dominates thoracic & abdominal parasympathetic supply up to proximal 2/3 of transverse colon. 🌿 SACRAL Parasympathetic (S2–S4) 🔹 Pelvic splanchnic nerves 🔹 Detrusor contraction 🔹 Rectal motility 🔹 Erectile vasodilation ⚠️ Pelvic splanchnics are PARASYMPATHETIC, not sympathetic. 🏥 Implications in REGIONAL ANESTHESIA 💉 Neuraxial Block 🔸 Sympathetic block occurs first 🔸 Parasympathetic tone remains unopposed 🔸 Relative vagal dominance ➡️ Bradycardia ➡️ Hypotension (from sympathetic loss, not parasympathetic excess) 🚨 High Spinal 🔹 Block of T1–T4 cardiac accelerator fibers 🔹 Dominant vagal tone 🔹 Severe bradycardia or asystole 🎯 Spinal bradycardia is a VAGAL phenomenon, not direct LA cardiac toxicity. 🫁 Fascial Plane Blocks (FPBs) 🔸 Do NOT block parasympathetic efferents 🔸 Visceral analgesia = sympathetic afferent modulation 🔸 No true parasympathetic blockade achievable 🏥 Implications in GENERAL ANESTHESIA 🫀 Airway & Vagal Reflexes 🔹 Laryngoscopy → Vagal stimulation 🔹 Opioid-heavy techniques → Increased vagal tone 🔹 Pediatric patients → Higher vagal responsiveness ➡️ Bradycardia ➡️ Bronchospasm 💊 DRUG INTERACTIONS 🔸 Opioids → Increase vagal tone 🔸 Propofol → Suppresses sympathetic tone → relative parasympathetic dominance 🔸 Volatiles → Alter autonomic reflex balance 🛑 Anticholinergics ▪️ Atropine ▪️ Glycopyrrolate ➡️ Block muscarinic receptors ➡️ Prevent/treat vagal bradycardia 🎓 TAKE HOME: 🧠 Parasympathetic system = craniosacral, organ-specific 🫀 Vagus nerve = central anesthetic player ⚖️ Most anesthetic events = autonomic imbalance 💡 Regional anesthesia → relative parasympathetic dominance 🚑 Clinical safety depends on anticipating vagal physiology

KartikBSonawane's tweet photo. 🧠 RA & ANS: E. Parasympathetic Nervous System - Anatomy • Connections • Anesthetic Implications 🎯

#ParasympatheticSystem #RAandANS #CraniosacralOutflow #VagusNerve #AutonomicBalance #RegionalAnesthesia #GeneralAnesthesia #SpinalAnesthesia #HighSpinal #Bradycardia #AnatomyMatters
#TipofTheDay #MyRATips

Tip of the Day:

🟢 CRANIOSACRAL OUTFLOW

🔹 Brainstem nuclei →CN III, VII, IX, X
🔹 Sacral spinal cord → S2–S4
🔹 Long preganglionic fibers
🔹 Ganglia located near or within target organs
🔹 Neurotransmitter: Acetylcholine (ACh)

🧩 NEUROCHEMICAL ORGANIZATION

🟡 Preganglionic → ACh → Nicotinic receptors
🟢 Postganglionic → ACh → Muscarinic receptors
🔵 Highly organ-specific response (localized effect)

👁 CRANIAL Parasympathetic Pathways

🔸 CN III → Pupillary constriction & accommodation
🔸 CN VII → Lacrimal & salivary secretion
🔸 CN IX → Parotid secretion
🔸 CN X (Vagus) → Heart, Lungs, GI tract

🔥 PEARL: Vagus nerve dominates thoracic & abdominal parasympathetic supply up to proximal 2/3 of transverse colon.

🌿 SACRAL Parasympathetic (S2–S4)

🔹 Pelvic splanchnic nerves
🔹 Detrusor contraction
🔹 Rectal motility
🔹 Erectile vasodilation

⚠️ Pelvic splanchnics are PARASYMPATHETIC, not sympathetic.

🏥 Implications in REGIONAL ANESTHESIA

💉 Neuraxial Block

🔸 Sympathetic block occurs first
🔸 Parasympathetic tone remains unopposed
🔸 Relative vagal dominance
➡️ Bradycardia
➡️ Hypotension (from sympathetic loss, not parasympathetic excess)

🚨 High Spinal

🔹 Block of T1–T4 cardiac accelerator fibers
🔹 Dominant vagal tone
🔹 Severe bradycardia or asystole

🎯 Spinal bradycardia is a VAGAL phenomenon, not direct LA cardiac toxicity.

🫁 Fascial Plane Blocks (FPBs)

🔸 Do NOT block parasympathetic efferents
🔸 Visceral analgesia = sympathetic afferent modulation
🔸 No true parasympathetic blockade achievable

🏥 Implications in GENERAL ANESTHESIA

🫀 Airway & Vagal Reflexes

🔹 Laryngoscopy → Vagal stimulation
🔹 Opioid-heavy techniques → Increased vagal tone
🔹 Pediatric patients → Higher vagal responsiveness
➡️ Bradycardia
➡️ Bronchospasm

💊 DRUG INTERACTIONS

🔸 Opioids → Increase vagal tone
🔸 Propofol → Suppresses sympathetic tone → relative parasympathetic dominance
🔸 Volatiles → Alter autonomic reflex balance

🛑 Anticholinergics
▪️ Atropine
▪️ Glycopyrrolate
➡️ Block muscarinic receptors
➡️ Prevent/treat vagal bradycardia

🎓 TAKE HOME:

🧠 Parasympathetic system = craniosacral, organ-specific

🫀 Vagus nerve = central anesthetic player

⚖️ Most anesthetic events = autonomic imbalance

💡 Regional anesthesia → relative parasympathetic dominance

🚑 Clinical safety depends on anticipating vagal physiology

656

Dr.Kartik Sonawane

@KartikBSonawane

8 months ago

💉⚔️ RA & ANS: D. Who Really Controls Surgical Stress? - GA vs RA #GeneralAnesthesia #RegionalAnesthesia #RAandANS #SurgicalStress #StressResponse #SympatheticNervousSystem #PerioperativeMedicine #AnesthesiaEducation #PainMedicine #NeuroendocrineResponse #AutonomicPhysiology #TipOfTheDay #MyRATips Tip of the Day: 🔹 Surgery is not just tissue injury. 🔹It is a neuroendocrine storm. 🔹The real question is not: “Is the patient asleep?” 🔹 It is: “Is the stress response truly controlled?” Let’s decode 👇 1. 😴 GENERAL ANESTHESIA (GA) ⚠️ Stress is masked, not necessarily blocked 🔹 Patient unconscious 🔹 Awareness abolished 🔹 But nociceptive signals may still reach spinal cord & hypothalamus Unless: Deep anesthesia High-dose opioids Alpha-2 agonists / beta-blockers The body may still activate: 🧠 Sympathetic nervous system 🧪 HPA axis 🔥 Adrenal catecholamine surge 📈 Physiological consequences: ➡️ Variable heart rate ➡️ Blood pressure swings ➡️ Elevated catecholamines ➡️ Increased cortisol levels ➡️ Hyperglycemia & inflammatory activation ⚠️ GA silences the MIND, but does not automatically silence PHYSIOLOGY. 2. 🟢 REGIONAL ANESTHESIA (RA) ✨ Stress is prevented at the source 🔹 Nociceptive input blocked before reaching CNS 🔹 Dorsal horn activation reduced 🔹 Sympathetic efferent output attenuated �� Adrenal catecholamine release blunted 🔹 RA interrupts the pathway before the cascade begins. 📉 Physiological consequences: ➡️ More stable hemodynamics ➡️ Lower stress hormone levels ➡️ Reduced metabolic disturbance ➡️ Improved postoperative recovery ⚠️ RA modifies PHYSIOLOGY, not just PERCEPTION. 🚨 High spinal / extensive epidural block If sympathetic tone is excessively suppressed: ➡️ Loss of vascular tone ➡️ Reduced adrenal compensatory response ➡️ Hypotension & bradycardia Stress response can become too weak, not just controlled. Balance matters. 3. ⚖️ GA + RA COMBINED 🎯 When combined intelligently, they complement each other. 🔹 RA blocks nociceptive input at the source 🔹 GA ensures unconsciousness and airway control 🔹 Lower anesthetic depth required 🔹 Reduced opioid requirement 🔹 Blunted sympathetic & hormonal surge 🔹 Improved hemodynamic stability 🔹 Enhanced recovery profile 📊 Physiological advantages: ➡️ Reduced catecholamine surge ➡️ Better BP control ➡️ Less endocrine stress activation ➡️ Lower postoperative pain scores ➡️ Decreased opioid-related side effects ⚠️ This is not COMPETITION, its strategic INTEGRATION. 🎯 TAKE HOME: 💉 RA doesn’t just provide analgesia, it rewrites the body’s stress response. 😴 GA mainly hides it. ⚖️ Together, when balanced well, they control it.

694

ASA® @ASALifeline

8 months ago

What is general anesthesia? What is an epidural? What kind of procedures are they used for? Drs. @SebasAmayMD and Joshua Insler, ASA members, answer your questions! #GeneralAnesthesia #epidural #colonoscopy #anesthesiology #anesthesiologist

JCM MDPI @JCM_MDPI

10 months ago

#mdpijcm #Editor’s Choice Paper🔍 Citations 14👏 #Remimazolam and Its Place in the Current Landscape of Procedural Sedation and #GeneralAnesthesia 👉https://t.co/6jb7M2ilHS @MediPharma_MDPI

JCM_MDPI's tweet photo. #mdpijcm
#Editor’s Choice Paper🔍
Citations 14👏
#Remimazolam and Its Place in the Current Landscape of Procedural Sedation and #GeneralAnesthesia
👉https://t.co/6jb7M2ilHS
@MediPharma_MDPI https://t.co/apsg54SBoS

Hemostasis Today

@HemostasisToday

12 months ago

General Anesthesia May Lead to Better Outcomes in Stroke Thrombectomy? @JAMANeuro @almuftifawaz | @RocChenMD https://t.co/IAk9RrgEPC #GeneralAnesthesia #Hematology #HemostasisToday #JAMANeurology #Medicine #Sedation #Stroke #Thrombectomy #VesselOcclusion #Thrombosis #MedEd #MedX

HemostasisToday's tweet photo. General Anesthesia May Lead to Better Outcomes in Stroke Thrombectomy?
@JAMANeuro
@almuftifawaz | @RocChenMD

https://t.co/IAk9RrgEPC

#GeneralAnesthesia #Hematology #HemostasisToday #JAMANeurology #Medicine #Sedation #Stroke #Thrombectomy #VesselOcclusion #Thrombosis #MedEd #MedX

316

ASA Monitor @ASAMonitor

about 1 year ago

“In some busy children’s hospitals, up to three ORs a day may be devoted to dental rehab procedures.” Learn about #GeneralAnesthesia for dental rehabilitation in the September @ASAMonitor AIRS Case Report. https://t.co/5B1wP7h4UX #PedAnes

ASAMonitor's tweet photo. “In some busy children’s hospitals, up to three ORs a day may be devoted to dental rehab procedures.”

Learn about #GeneralAnesthesia for dental rehabilitation in the September @ASAMonitor AIRS Case Report.

https://t.co/5B1wP7h4UX
#PedAnes https://t.co/KmzJ05ZFk1

251

ThaiPBS Sci & Tech

@ThaiPBSSciTech

about 1 year ago

การ #วางยาสลบ ถือเป็นหนึ่งในขั้นตอนใหญ่ของการ #ผ่าตัด ที่ต้องเฝ้าระวังเป็นพิเศษ โดยเฉพาะอย่างยิ่งในผู้ที่ไม่เคยเข้ารับการผ่าตัดด้วยยาสลบแบบ #GeneralAnesthesia มาก่อน 📌อ่านต่อ : https://t.co/vJPPqpfcdw #ThaiPBSSciAndTech #ThaiPBS

ThaiPBSSciTech's tweet photo. การ #วางยาสลบ ถือเป็นหนึ่งในขั้นตอนใหญ่ของการ #ผ่าตัด ที่ต้องเฝ้าระวังเป็นพิเศษ โดยเฉพาะอย่างยิ่งในผู้ที่ไม่เคยเข้ารับการผ่าตัดด้วยยาสลบแบบ #GeneralAnesthesia มาก่อน

📌อ่านต่อ : https://t.co/vJPPqpfcdw

#ThaiPBSSciAndTech #ThaiPBS https://t.co/FVuC8yRtNE

307

Alice Worth @Scitech_surgery

over 1 year ago

#GeneralAnesthesia: Ensuring Painless Surgeries General anesthesia allows surgeons to perform complex procedures while keeping patients unconscious & pain-free. Advancements continue to enhance safety, precision, & recovery. Explore more at #Surgery2025: https://t.co/cdd5ziBHiD

JHS GO @JHSGlobalOnline

almost 2 years ago

A Prospective Study Comparing Wide-Awake #LocalAnesthesia No Tourniquet Versus General Anesthesia in #HandFracture Fixation @ukm_my #FractureFixation #GeneralAnesthesia #WALANT #JHSGO #HandSurgery #OpenAccess https://t.co/72cEo3JRyx

100

A Chronic Voice @AChVoice

almost 2 years ago

“The findings could influence #clinical #anesthesia dosing for women, which today is still largely guided by data disproportionally collected from males": https://t.co/3ioreQfTAp via @nautilusmag #surgery #MedTwitter #GeneralAnesthesia

DailyMedicalinfo ديلي ميديكال انفو

@DMedicalinfo

almost 2 years ago

#التخدير_الكامل هو إجراء يستخدم لجعل المريض في حالة من اللاوعي وفقدان الإحساس بالألم تمامًا خلال خضوعه للجراحة، وفي المقال التالي سنتحدث عن المزيد من المعلومات الضرورية المتعلقة بهذا النوع من التخدير #dailymedicalinfo #GeneralAnesthesia https://t.co/FhdbGirPSn

OpenAnesthesia® @openanesthesia

almost 2 years ago

Neuromuscular blockade is often required in #generalanesthesia to provide optimal #surgical conditions, & a depolarizing NMB (#succinylcholine) still has a part in #anesthesia. #anesthesiology #MedEd #MedTwitter Visit https://t.co/JdjEfjuHuH

openanesthesia's tweet photo. Neuromuscular blockade is often required in #generalanesthesia to provide optimal #surgical conditions, & a depolarizing NMB (#succinylcholine) still has a part in #anesthesia. #anesthesiology #MedEd #MedTwitter Visit https://t.co/JdjEfjuHuH https://t.co/tSwW35NkdU

556

UTSW Anesthesiology @UTSW_Anesthesia

about 2 years ago

Welcome Dr. Eric Tretter to the UT Southwestern Department of Anesthesiology and Pain Management! #anesthesiology #generalanesthesia #regionalanesthesia #teamwelcome

UTSW_Anesthesia's tweet photo. Welcome Dr. Eric Tretter to the UT Southwestern Department of Anesthesiology and Pain Management!

#anesthesiology #generalanesthesia #regionalanesthesia #teamwelcome https://t.co/KpMsMJtRGn

182

Nayef Al-Rodhan

@SustainHistory

about 2 years ago

Study reveals how an anesthesia drug induces #Unconsciousness Propofol, a drug commonly used for #GeneralAnesthesia, Derails the #BrainNormalBalance Between #Stability & #Excitability. https://t.co/1BOFoqVGhv

201

OpenAnesthesia® @openanesthesia

over 2 years ago

Neuromuscular blockade is often required in #generalanesthesia to provide optimal #surgical conditions. How do you assess adequacy of blockade & reversal? What do you look for using a twitch monitor? #anesthesia #anesthesiology #meded #medtwitter Answer at https://t.co/7wVIYY1k3G

openanesthesia's tweet photo. Neuromuscular blockade is often required in #generalanesthesia to provide optimal #surgical conditions. How do you assess adequacy of blockade & reversal? What do you look for using a twitch monitor? #anesthesia #anesthesiology #meded #medtwitter Answer at https://t.co/7wVIYY1k3G https://t.co/bW6oHIyFtB

669

DailyMedicalinfo ديلي ميديكال انفو

@DMedicalinfo

over 2 years ago

التخدير الكامل او التخدير العام إجراء يستخدم لجعل المريض في حالة من اللاوعي وفقدان الإحساس بالألم تمامًا خلال خضوعه للجراحة، وفي المقال التالي سنتحدث عن المزيد من المعلومات الضرورية المتعلقة بهذا النوع من التخدير #GeneralAnesthesia #dailymedicalinfo https://t.co/FhdbGirPSn

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